Pharmacy Formulary and Medical Policy Changes for January 2026

Beginning January 2026, some drugs will experience a formulary drug list change. Read more about formulary drug list changes.

Premera is making additional changes to the Essentials formulary, including:

• Starting January 1, 2026, if a pharmacy tries to fill a medication that isn’t covered, they’ll still get a rejection message—but they’ll also see information about preferred alternatives.
• The Essentials formulary exclusion list will be called the Essentials Non-Formulary list with preferred alternatives
• In 2026, we’ll add more multi-source brands, non-preferred biosimilars, and high-cost generics (with lower-cost options) to the High-Cost Low-Value (HCLV) and Essentials Non-Formulary lists.

Also, starting January 2026, the following drugs will require a new prior authorization:

How we’re notifying members: Impacted members received a letter in November 2025 notifying them of the change or the member’s provider was notified of the change in our October 2, 2025 issue of Provider News.

If you have any questions about these formulary and prior authorization changes, please contact your Premera representative.